I have read your articles on blood pressure, which recommend progressing clients at a rate of 10% per week. My client has controlled hypertension and has exercised all her life. When we started personal training, I recommended low intensity cardio exercise. Could we start progressing at a rate of 10% a week up to 85% max HR? If yes, are there any signs we can look out for that imply we are moving too quickly? Also, would boxing be appropriate for a client with hypertension?
For clients with mild hypertension, ACSM recommends following an exercise program that includes at least 30 minutes per session, most days of the week of moderate intensity (50-85% of maximal oxygen uptake). For clients with stage 2 or 3 hypertension, exercise intensity should range from 40-70% of maximal oxygen uptake. In addition, the American Heart Association recommends mild to moderate resistance training at intensities of 30-60% of maximal effort for improving muscular strength and endurance, thereby managing and modifying coronary risk factors such as hypertension.
Since your client has exercised her entire life, a progression of 5-10% would be safe with strict fitness evaluation after each week. It is also beneficial to include a couple of weeks of a 5-10% progression in volume followed by a week of baseline exercise intensity again to allow the body a recovery phase. A consistently high resting heart rate and elevated blood pressure could indicate signs of overload as would general fatigue. It is recommended to monitor resting heart rate two to three times per week and blood pressure on a weekly basis during a progressive exercise program.
For clients with stage 1 or 2 hypertension, it is recommended that exercise activities be mostly dynamic and less static. Dynamic exercises include swimming, cycling, walking and cross country skiing. Exercises that are not recommended include rowing, boxing, tennis and competitive ball sports. However, if boxing is done as a means of cardiovascular conditioning and is not done in a ring with a sparring partner, it could be considered an aerobic exercise, therefore maintaining the proper progression and intensity ranges described above should be the focus. For clients with stage 3 hypertension, most static or isometric exercises should not be instituted.
According to the ACSM Position Statement, the following should also be considered:
- People using medications, such as beta-blockers, should be cautious of developing heat illness when exercising. These medications and diuretics impair the ability to regulate body temperature.
- Adults with hypertension should extend the cool down period of the workout. Antihypertensives, such as alpha blockers, calcium channel blockers and vasodilators may cause BP to lower too much after abruptly ending exercise.
- A physician evaluation and clearance is necessary for those with severe or uncontrolled BP prior to beginning an exercise program. Higher risk patients (such as those with coronary artery disease or chronic heart failure) should lessen the intensity of their training program.
- Hypertension in athletes and active patients, tailoring treatment to the patient. The Physician and Sports Medicine, volume 27, number 4. April 1999.
- Exercise guidance in hypertension. The Physician and Sports Medicine, volume 28, number 10. October 2000.
- Pollock ML, Franklin BA, Balady GJ, et al: Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription: an advisory from the committee on exercise, rehabilitation, and prevention, Council on Clinical Cardiology, American Heart Association. Circulation 2000;101(7):828-833.
- Exercise and hypertension. ACSM Position Stand, 2004.